Lead Poisoning Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain

Abstract

Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain.

Occupational Lead Poisoning in a Patient with Acute Abdomen and Normocytic Anemia

“…Lead poisoning can be misdiagnosed as nonspecific abdominal pain or acute porphyria ( 8 , 9 ). Both porphyria and lead poisoning can impair the heme biosynthetic pathway, potentially leading to limited heme production.…”

Lead Poisoning Caused by Traditional Chinese Medicine: A Case Report and Literature Review

“…Lead poisoning can be misdiagnosed as nonspecific abdominal pain or acute porphyria. There are two reported cases of misdiagnosis of lead poisoning as porphyria (Markowitz et al 1994;Tsai et al 2017). Both porphyria and lead poisoning can impair the heme synthetic pathway, leading to potentially limited heme production.…”

“…We identified 10 relevant case reports (Lightfoote et al 1977;Markowitz et al 1994;Auyeung et al 2002;Woolf et al 2008;Prakash et al 2009;Lin et al 2012;Wu et al 2013;Deng et al 2016;Ying et al 2016;Tsai et al 2017) from 1977 to 2017 (Table 1). To summarize these, the reasons for taking TCM varied across individuals.…”

Al2O3/Yttria‐Stabilized Zirconia Hollow‐Fiber Membrane Incorporated with Iron Oxide for Pb(II) Removal

“…Iron oxide particles would assemble around the CTAB micelle formed. The addition of urea was to provide a steady but low concentration of OHgroup for Fe 3+ to form Fe(OH) 3 [22]. CTAB was removed through a calcination process to facilitate the generation of porous iron oxide [23,24].…”

“…Industrial effluents are in fact the main anthropogenic sources of heavy metal ions such as Pb(II) ions. Human exposure to Pb(II) ions can cause abdominal pain and interfere with brain development, prompting nervous system damage [2][3][4]. In addition, Pb(II) ions have been reported to have no physiologic role in the biological system [5].…”